Tired after a long shift – but driving home anyway?

What our survey reveals about the risks faced by nurses, particularly after night shifts

• A quarter of respondents to a Nursing Standard survey say they have had an accident or near-miss after a tiring shift
• While many nurses say they prefer 12-hour shifts, limited access to rest areas and breaks contribute to safety concerns
• Naps during breaks are being seens as a ‘safety intervention’ at some trusts

As many as one in four nurses have had a car accident or near-miss when driving home tired after a shift, a Nursing Standard survey suggests.

Nurses described falling asleep at the wheel during the journey, with one revealing: ‘I crashed into a tree and rolled my car on [the] way home from a night shift. Amazingly no serious injuries.’

The survey - which was undertaken prior to the COVID-19 pandemic - found that, of the 2,000 UK nurses who told us they drive to work, three-quarters reported feeling tired or drowsy on the journey home.

In total, 7% of drivers admitted having fallen asleep at the wheel.

Driving risks associated with night shifts

One respondent told how two colleagues had been killed in a road traffic accident on their way home from work, while another said: ‘Tired every shift. Had two accidents in the last two years from falling asleep.’

Another said: ‘I was driving home from a night shift and woke up just as I was about to drive into a row of parked cars.’ 

Another commented: ‘Fell asleep while driving home from night duty.’

• RELATED: Fight Fatigue campaign urges NHS to improve working conditions

The online survey found that safety incidents while driving often happened following long night shifts.

Respondents reported that a lack of rest areas for breaks during and after shifts poses a safety risk, with some threatened with dismissal if they took a nap during their break.

In response to our findings, health leaders called on employers to ensure nurses have adequate breaks – and that shifts are adequately staffed – to protect their safety.

The findings are part of a wider survey on workplace issues which included 14 multiple choice questions and free text comments. A total of 2,525 nursing staff responded to the poll conducted via SurveyMonkey, with not all respondents replying to every question.

Lack of facilities for breaks

Many nurses reported having no access to adequate rest facilities during or after their shifts, including shower facilities (68%) or, in some cases, drinking water (18%). Nearly a third of all respondents (31%) had no access to a dedicated staff or rest room.

Only a tiny minority of respondents [3%] had access to an area to sleep in; one nurse said they had resorted to having a power nap in their car after night shifts before setting off for home.

• RELATED: Off-guard image of exhausted midwife goes viral

One respondent points out: ‘Even within the half an hour break we are allowed, having five or ten minutes’ nap can help to refresh [us] for the rest of the afternoon.’ 

Research from NASA shows astronauts increase their effectiveness by more than 30% following a nap of 14-19 minutes. 

Naps are a ‘safety intervention’

Sleep expert John Groeger agrees that naps are ‘tremendously important’ and says they may be enough to keep a nurse going on a 12-hour shift and get them home safely.

• RELATED: Naps during your breaks: could it make long shifts safer?

‘Napping is restorative and should be something we look at more closely. It is not fecklessness, it is a physiological fact,’ says Professor Groeger, head of the SleepWell Lab at Nottingham Trent University.

‘Napping at work won’t resolve the problem, but it will help to relieve it.’

Naps during breaks are a ‘safety intervention’ encouraged for nurses at one trust in southwest England.

The approach is one of a series of principles intended to safeguard staff working long shifts, agreed by nurses and union representatives at Gloucestershire Hospitals NHS Foundation Trust.

Oxford University Hospitals NHS Foundation Trust trialled specialist sleep pods and chairs for its emergency nurses to take short power naps during their breaks for a trial during the COVID-19 pandemic.

• RELATED: Power nap booths help Oxford emergency nurses fend off fatigue and stress

However, managers in other trusts and settings are often opposed to sleep breaks, according to our respondents, some of whom have been told they will be sacked if they sleep during their shifts. 

‘Sleep in unused rooms overnight on break, but it is “frowned upon” and [we] have had access to sheets and blankets removed,’ said one respondent.

Another said: ‘Not allowed to nap anywhere. Instant dismissal threats.’

One nurse said they had been warned that if they slept on duty, they would be disciplined.

We underestimate the effects of night shift work

Professor Groeger says the problem is that employers – and society at large – ‘underestimates hugely’ the effect that shift-working, particularly at night, has on sleep and people’s health.

He explains that sleepiness increases through the night and hits ‘a bad patch’ somewhere between 2am and 6am, whether the person is asleep or awake.

‘This is the point at which when sleeping we are at our coldest, our heart rate is slowing – all sorts of things are happening, like a reset button for the day.’

• RELATED: Study will explore naps for night shift nurses

Professor Groeger says at the end of a night shift when someone is tired, switching tasks to something new can mean concentration is difficult to maintain.

He says a ‘simple’ task such as driving can seem easy after a tough night’s work, but in fact attention is more likely to wander because the person’s energy is so depleted.

‘It doesn’t surprise me that people will feel they have been sleepy on the way home, dropped off a bit, had near-misses or accidents,’ he says.

He points to academic research that studied nurses’ eye movements driving to and from work. This found inattention while driving was three times more likely to occur on the drive home following a shift, compared with driving to the shift. 

At their most tired, nurses’ eyes were closed for more than 7% of each minute. For a 30-minute drive travelling at 60km per hour (37mph) this translates to the nurse driving approximately 2.1km (1.3m) with their eyes closed during the journey.  

Nurses working shifts were more than eight times more likely to experience hazardous driving events, including having a near-miss incident during the commute home, following an 8-10 hour shift, compared with during their drive to work.

Professor Groeger says: ‘That means shift-working nurses, and others they encounter, are at a greater risk on their way home and of course that is a problem.’

A duty of care to look after staff

RCN national health, safety and well-being officer Kim Sunley says Nursing Standard’s findings should be ‘a wake-up call’ to employers in terms of the impact of long or break-free shifts on nursing staff.

‘More needs to be done,’ says Ms Sunley. ‘Employers who have nurses working shifts have a duty of care to look after their staff.’

The college helped produce joint guidance with the NHS Staff Council outlining steps to mitigate risks to shift workers, published at the start of 2020.

• RELATED: How to create a ‘take a break’ culture

‘There are small pockets of good practice and we want it to be spreading throughout the NHS and hopefully the guidance will help that,’ adds Ms Sunley.

The nursing workforce crisis and the COVID-19 pandemic are adding to the problem, Ms Sunley says, as nursing rota gaps are being filled using ‘silly shift patterns’.

‘In the current system, there might be a temptation to work even longer, but employers have got to do more prevent fatigue and awful accidents happening on the way home,’ says Ms Sunley.

Serious and fatal car accidents

In 2017, a nurse in Scotland survived after crashing her car following a 12.5-hour night shift in which she had not had a break, prompting Unison to warn nurses were ‘running on empty’.

Others have not been so lucky. In West Yorkshire, emergency nurse Julie Marlow died in a car crash following a night shift in 2018.

Acknowledging the number of healthcare workers involved in serious and sometimes fatal car accidents when driving home, NHS Staff Council guidance suggests some good practice for employers.

• RELATED: 12-hour shifts: they may offer nurses work-life balance, but are they worth the risk to safety?

This includes quiet rest areas where the driver can have a ‘power nap’ before driving home, the provision of taxis, or someone to take the person home.

It points out that accidents are ‘a particular risk where the shift has gone on longer than expected due to an emergency or unforeseen circumstance’.

Ms Sunley adds that shift working is a fact of life in healthcare, but says risks could be mitigated by employers and urges them to pay attention to the guidance and the college’s Rest, Rehydrate, Refuel campaign.

Driving home at night after a long shift? 

Independent road safety charity IAM RoadSmart says anyone driving when they would normally be asleep is prone to a fatigue-related crash. 

The organisation's head of driving behaviour, Rebecca Ashton, offers the following tips:

• Do not get into a car feeling tired. A brief spell of exercise can aid alertness
• Try not to hurry, and drive in a defensive way
• If you start to feel sleepy, stop and have a short break of at least 20 minutes. The temptation of thinking you will be home in ten minutes can be difficult to overcome, but it is always safer to stop even if you are close to home
• A cup of coffee or an energy drink will only revive you for a short time and can make you feel worse after it has worn off
• Other fatigue ‘hacks’ such as opening the window or turning up the radio will only give a quick fix
• No one suddenly feels tired, but micro sleeps can creep up on you if you drive feeling sleepy

Ms Ashton says: ‘Driving to and from work can be risky, particularly if the journey is after a long shift, a night shift or before an early start – all of which are faced by people in the healthcare profession on a daily basis. 

‘Unfortunately there is no easy fix to the problem – the safest measure is to use public transport or taxis. However, these are not always available or financially realistic.'

Staff rooms do not always offer a suitable place to rest

Nursing Standard’s survey shows that, even for those nurses who do have access to a staff room on breaks, this does not always constitute a rest.

‘People use the staff room to sleep,’ reported one respondent. ‘However, this does leave people like myself who don't sleep with nowhere to go on my break at night.’

One nurse said there was ‘insufficient room’ in the staff rest area, which catered for more than 200 people.

Another highlighted the noise in the staff room on their ward and the constant interruptions.

Fight Fatigue campaign

Meanwhile, a drive to raise awareness of the impact of fatigue and shift work on NHS staff is gaining momentum.

The Fight Fatigue campaign was set up by the Association of Anaesthetists (AoA), the Royal College of Anaesthetists and the Faculty of Intensive Care Medicine following the death of a trainee anaesthetist who fell asleep while driving home tired after a night shift in 2015.

Now, the campaign has been backed by Health Education England.

• RELATED: Night shift guide: a nursing student shares her 9 top tips

AoA president Kathleen Ferguson says the Nursing Standard survey findings are ‘an alarming wake-up call’ and that fatigue is a reality that affects all healthcare professionals. 

Dr Ferguson adds: ‘We believe it is time to acknowledge that a culture change is needed across health services to ensure that staff working at night are appropriately supported to stay safe.’

Further information

• Help Fight Fatigue campaign
• RCN Rest, Rehydrate, Refuel campaign
• Government advice on rest breaks at work